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Members - Prescription Benefits
 

Eligibility

Members of GVHP are eligible to participate in the Prescription Benefit if their employer has purchased a prescription drug rider. Members who do not have the Prescription Benefit may utilize the services of the two GVHP Pharmacies located at the Beckwith and Wyoming Health Centers. For those without the Prescription Benefit, you may wish to check our price before having your prescription filled at a local pharmacy.

Pharmacy Providers

GVHP operates two Pharmacies located at the following Health Centers: Beckwith HC (on Leonard NE just off of I-96), and Wyoming HC (on Clyde Park SW at the corner of 52nd Street). Our pharmacists will provide members with drug information on every new prescription and inform them of any significant warnings on side-effects or drug interactions at the time their prescription is dispensed. The pharmacy staff are a part of your healthcare team and work closely with your provider to assure the best possible outcome from your medications. Members may also have prescriptions filled at participating pharmacies in the MedImpact Managed Care Network. Should you have any questions about the pharmacies participating in this network, please call Customer Services at (616) 949-2410. Should you require a prescription outside of Michigan, you will need to pay cash for your prescription. Upon approval by your Health Center, you will be reimbursed at the approved GVHP amount less your copay.

Eligible Expenses

Your prescription is covered when ordered by a GVHP practitioner or a specialist approved by a Health Center practitioner for the treatment of an injury or illness. It should also be recognized as being appropriate treatment of the injury or illness. Some prescription drugs, as defined in the section on Exclusions, are not covered. Insulin syringes are covered at no additional copay when purchased with an insulin prescription.

Amount of Benefits

GVHP will pay the cost of the prescription drug after the member pays the applicable co-payment amount. This amount is stated in your Prescription Benefit Rider and appears on your membership card. However, approved prescription infertility drugs, growth hormones and anti-hemophilia factor are subject to a 50% co-payment. Drugs used for in vitro fertilization are not covered by your benefit.

Lost Medications

A quantity not to exceed a 30 days supply of lost medication will be replaced. The member will be charged the cash price of the prescription.

New and Termed Members

GVHP Pharmacies will fill an initial one-month supply of refillable medications from a previous physician until the member can receive approval for their medications from a GVHP practitioner. Prescriptions cannot be refilled early due to pending loss of GVHP coverage. Prescriptions can be transferred to another pharmacy of the member's choice with all remaining refills.

Over-the-Counter Medications

The GVHP Pharmacies stock a limited number of cough and cold, analgesic and other non-prescription products for your convenience at discounted prices. Special orders are available, usually on the following day if ordered by 4 PM.

Oral Contraceptives (If not covered by your benefit)

You may wish to check with our Pharmacies if you do not have oral contraceptive coverage. GVHP Pharmacies have negotiated special discounts with selected pharmaceutical manufacturers and this savings is passed along to GVHP members.

Dental Prescriptions

These prescriptions are not covered by your Prescription Benefit. However, as a courtesy, prescriptions for short-term therapy generally following a dental procedure, may be filled at a GVHP Pharmacy. Prescriptions for preventative products to be used long term are only covered if approved by the Pharmacy and Therapeutics Committee and your GVHP provider and filled through a GVHP Pharmacy.

Emergency Prescriptions

Each Health Center stocks a limited supply of medications which can be dispensed on your visit to the Health Center when our Pharmacies are closed or Pharmacy service is unavailable at the Health Center. Each prescription has a full course of therapy and you will be charged your copay at the Health Center when these medications are dispensed. Our GVHP Pharmacies will include these drugs in your medication profile on the Pharmacy Computer System. If you do not have your Prescription Rider with GVHP, you will be charged a cash price or given a written prescription to take to a local pharmacy in your area.

Allowable Quantities

Your prescription will be filled with a 30-day supply of most medications. GVHP maintains a 90-Day Drug List that is subject to change without notice by the Pharmacy and Therapeutics Committee. A 90-day supply of drugs on this list may be obtained for one copay if your provider determines this is appropriate for you. Drugs on the 90-Day Supply List are only available at your GVHP Pharmacies. If a generic substitute is available, it must be filled with a generic in order to receive a 90-day supply. If a member requests a brand name where a generic is available on this list of drugs, it may only be filled with a 30-day supply. Certain drugs are limited to less than a 30 day supply, e.g. migraine, impotency, etc., due to the nature of the drug, or the decision of your provider or the Pharmacy and Therapeutics Committee. The 90-Day Supply List is available at your GVHP Pharmacy. Also, see section on Generic Policy.

Payment/Delivery

Payment for prescriptions is expected at the time of service. For your convenience, our Pharmacies accept cash, checks and/or credit and debit cards. Free delivery of most prescriptions via mail is available only with payment in advance. Federal Regulations prohibit mailing of certain medications. Your Pharmacy will inform you of these. If your Health Center does not have a Pharmacy, we can deliver your filled prescription to them for pickup. Payment can be made at the time it is received.

Generic Policy

Prescriptions for which there is a generic substitute available will be filled with the generic product. If your Provider documents that it is therapeutically necessary that you have a brand name drug, he may request DAW (dispense as written) on your prescription. If members request brand name products, they will be charged the cost difference between the brand and generic drug plus their copay.

Refills

You will receive same day service at your GVHP Pharmacies on prescriptions, which are refillable. Refills should be requested when 75% of the prescription has been used. All refill requests on expired prescriptions are processed through the Pharmacies and require a 48 hour waiting period for medical record review. By Michigan Pharmacy Rules, the Pharmacy must have the original prescription before it can be dispensed.

Exclusions include but are not limited to:

  1. Investigational. Any drug labeled "Caution: Limited by Federal Law to Investigation Use".
  2. Cosmetics, medicated soaps, transdermal anti-nausea patches used for travel sickness, smoking cessation products, drugs for travel abroad, test kits, nebulizers, and support garments
  3. Cost for nonprescription drugs
  4. Oral contraceptives unless added as a rider to the Prescription Benefit - diaphragms are not covered
  5. Medications which have a therapeutic over-the-counteralternative
  6. F.D.A. Approved Drugs which are prescribed for a use, which is not approved by the F.D.A.
  7. Anorexant diet medications

If you would like a copy of any of our Pharmacy Management Procedures, please contact Customer Service at (616) 949-2410.